Zygoma fracture

3. Diagnosis
Signs and symptoms
 Periorbital ecchymosis, edema.
 Pain, Numbness (infraorbital nerve)
 Step deformity at orbital margin
 Trismus
 Subconjunctival hemorrhage
 Unequal pupillary level
 Diplopia
 Enophthalmos
 Signs of blowout fracture.(extraocular muscle entrapment)
 Cosmetic deformity with facial widening

4. Imaging
Coronal and Axial cuts
3D is beneficial
Axial cut
Coronal cut

5. Various surgical approaches and
treatment strategies have been
proposed to obtain successful
treatment outcome, including the
Gilles temporal approach, coronal,
eyebrow, upper eyelid,
transconjunctival, infraciliary lower
eyelid, and intraoral vestibular
approaches
Surgical treatment:

6. Treatment plan:
1- Fractured reduced and stable
No surgical treatment-
Management of hematoma,
and edema.
2- Fracture with minimal displacement.
Zygomatic complex fractures with no or
minimal displacement are often treated without
surgical intervention, whereas fractures with
functional or esthetic impairments in the form
of diplopia, extraocular muscle entrapment,
malocclusion, restricted mouth opening and/or
depression of the malar prominence often
necessitate surgical intervention.

7. 3- Zygomatic arch fracture with displacement.
Surgical treatment:

10. A Rowe zygomatic elevator is inserted just deep to
the depressed zygomatic arch and an outward
force is applied.
Rowe elevator
Temporal Gillies approach

11. 4- Zygomatic complex fracture with displacement.
 Open reduction without fixation.
 Open reduction with one point fixation.
 Open reduction with two point fixation.
 Open reduction with three point fixation.
 Open reduction with four point fixation.
 Reconstruction of orbital floor may be
added to any previous line of treatment.

12. Open reduction without fixation.
Reduction with Gillies approach.

13. Open reduction without fixation.
A threaded reduction tool (Carroll-
Girard screw) is inserted into the
zygoma through the lower eyelid
incision or directly through the skin of
the face and used for reduction. Carroll-Girard screw

14. Open reduction with one point fixation.
Intra-Oral
approach with
miniplate
osteosynthesis

15. Open reduction with two point fixation.
Zygomatic
o-maxillary
Zygomatic
o-frontal

16.  Open reduction with three point fixation.
Zygomatico-
maxillary
Zygomatico-
frontal
Orbital rim.
Orbital floor
reconstruction.

17. Zygomatico-
maxillary
Zygomatico-
frontal
Orbital rim.
Zygomatico-
Temporal
 Open reduction with four point fixation and
reconstruction of orbital floor.